Icodextrin's effects on peritoneal transport

Abstract

Objective: To give a survey of the principles of peritoneal fluid transport in general, followed by an analysis of the effects of icodextrin on the transport of fluid and solutes. Design: A review of the literature and of data on the effects of icodextrin in continuous ambulatory peritoneal dialysis (CAPD) patients at the Academic Medical Center, Amsterdam. Results: Icodextrin had no effect on the mass transfer area coefficients of low molecular weight solutes. Also no effect was found on the clearances of albumin and larger serum proteins. Due to convective transport, the clearance of β2-microglobulin was greater with icodextrin than with glucose solutions. Icodextrin was especially superior to glucose in the induction of net ultrafiltration during long dwells, during peritonitis, and in patients with ultrafiltration failure caused by a large effective peritoneal surface area. Conclusion: Icodextrin has no effect on the permeability characteristics of the peritoneal membrane, but increases convective flow through the small-pore system. As a result, the peritoneal clearance of β2-microglobulin is higher than with glucose-based solutions. Icodextrin is especially indicated for long dwells and in patients with impaired ultrafiltration caused by a large peritoneal surface area, leading to high transport rates of low molecular weight solutes.